特发性震颤与帕金森病的认知障碍

Cognitive dysfuctions associated with essential tremor and Parkinson′s disease

目的：了解特发性震颤（ ET）患者、帕金森病（ PD）患者和健康对照组的认知障碍发生情况及相关因素。方法2009年9月至2013年9月采用蒙特利尔认知评估（ MoCA ）、汉密尔顿抑郁量表（ HAMD）对苏州大学附属第二医院门诊的62例ET患者、61例PD患者和60名健康对照组的认知功能及抑郁进行评估。结果认知障碍在ET患者发生率为38.7％，PD患者发生率为44.3％，健康对照组发生率为23.3％，差异有统计学意义（ P＜0.05）。健康对照组、ET组、PD组3组MoCA各因子比较结果：视空间/执行得分为（4.1±1.0）分、（3.8±1.1）分和（3.2±1.6）分，命名得分为（2.9±0.4）分、（2.8±0.6）分和（2.3±0.8）分及延迟回忆得分为（3.9±0.9）分、（2.7±1.3）分和（2.5±1.7）分，差异均有统计学意义（均P＜0.01），而注意力、语言、抽象及定向差异无统计学意义；进一步两两比较ET组与PD组MoCA各因子比较结果：两组视空间/执行得分为（3.8±1.1）分和（3.2±1.6）分，命名得分（2.8±0.6）分和（2.3±0.8）分，差异有统计学意义（P＜0.05），而两组命名、注意力、语言、抽象、延迟回忆及定向差异无统计学意义。 ET患者的认知功能评分与血尿酸、教育水平、抑郁评分和TRS评分显著的相关性（r＝0.589，P＝0.000；r＝0.449，P＝0.010；r＝0.452，P＝0.009；r＝0.466，P＝0.025）， PD患者的认知功能评分与血尿酸、教育水平、抑郁评分和UPDRS-Ⅲ评分显著的相关性（ r＝0.694， P＝0.000；r＝0.614， P＝0.000； r＝0.604， P＝0.000； r＝0.376， P＝0.000）。结论最常见的两个运动障碍疾病ET和PD认知障碍有较高发生率，常见症状多为视空间能力下降、执行力差、延迟回忆能力下降等，ET组视空间/执行能力、命名能力受损较PD是轻度的。认知功能评分与受教育年限、血尿酸水平呈正相关，与抑郁评分、运动障碍评分呈负相关。

Objectve To explore the incidence of cognitive dysfunction and associated factors in 62 essential tremor （ET） cases, 60 normal controls and 61 Parkinson′s disease （PD） cases.Methods A total of 62 ET and 61 PD patients from September 2009 to September 2013 were recruited from our outpatient clinic.ET patients received the Tremor Rating Scale for Tremor-motor examination （ items 1-15 of rating scale） while 61 PD patients were examined with the Unified Parkinson′s Disease Rating Scale （ UPDRS）-motor examination and a modified Hoehn and Yahr scale for staging disorder severity .All participants completed Montreal Cognitive Assessment （ MoCA） Beijing version for measuring cognitive functions .And depression was evaluated by the Hamilton Depression Scale （ HAMD） .The serum levels of uric acid were tested.Results A MoCA score 〈26 （ at least mildly cognitive ） was observed in 14 （ 23.3%） normal controls, compared to 24 （38.7%） ET cases and 27 （44.3%） PD cases （ P=0.045 when comparing all 3 groups, and P=0.532 when comparing ET and PD ）.The factor scores of visual space/execution were 4.1 ±1.0, 3.8 ±1.1 and 3.2 ±1.6 in normal controls, ET and PD patients, the factor scores of naming 2.9 ±0.4, 2.8 ±0.6 and 2.3 ±0.8 in control, ET and PD patients, the factor scores of delay memory 3.9 ±0.9, 2.7 ±1.3 and 2.5 ±1.7 in control, ET and PD patients.Statistical differences existed in visual space/execution , naming and delay memory （ P〈0.05 ） among 3 groups.Yet there were no statistical differences in attention , language , abstract and directional among 3 groups.Statistical differences existed in visual space/execution and naming between ET and PD patients （ P〈0.05）.PD cases had the lowest visual space/execution score , followed by ET （ intermediate ） and highest scores in controls （ P〈0.05 ）.In ET patients, cognitive scores were correlated with serum levels of uric acid , education, tremor Rating Scale for Tremor-motor subscale score and depression levels （ r =0.589, P=0.000; r =0.449, P =0.010; r =0.452, P=0.009;r=0.466, P=0.025）.In PD patients, cognitive scores correlated with serum levels of uric acid, education, score of UPDRS-Ⅲ and depression levels （ r=0.694, P=0.000; r=0.614, P=0.000;r=0.604, P=0.000;r=0.376, P=0.000）.Conclusion The incidence of cognition is higher in ET and PD.There were no significant inter-group differences for cognition frequency.The most frequently endorsed symptoms were poor visual spatial ability , execution disturbance and delayed recall disorders.Some connition scores in ET were intermediate between those of PD cases and normal controls .Thus a mild form of connition dysregulation may be present in ET.The degree of cognition symptoms is correlated with serum levels of uric acid , education and serious motor.